Laserfiche WebLink
Agreements <br />Labor Code Compliance Acknowledgement <br />Applicant hereby acknowledges that he/she is aware of and agrees to comply with the provisions of Labor Code Section 3700 that <br />requires every employer to secure the payment of compensation 'ar liability under the State's worker compensation law. Applicart <br />hereby submits proof that the payment Of compensation for liability under the State s worker compensation law has been secured in a <br />lawful manner. <br />Applicant understands and acknowledges that any mssrepresentaban, faisificatron, or material omission on this app'ication or any <br />document submitted in connection herewith Is grounds for den,al or this application or subsequent revocation of registration, <br />Applicant hereby agrees to compiete an IRS form 8821, Tax Information Authorizat on and submit it to the IRS. <br />The undersigned hereby certifies under penalty of perjury that the statements made and information provided on this application are <br />true and correct and that the applicant is in complete compliance with local government's business licensing and regional regulatory <br />requirements. <br />ANY MATERIAL MISREPRESENTATION 15 GROUNDS FOR DENIAL OR SUBSEQUENT REVOCATION OF A LICEN5E/REGISTRATION. <br />Labor Code Compliance Acknowledgement <br />I Acknowledge Labor Code Cornpiiance. Yes <br />Enter Your Name, Donald E Seaman <br />Registrat,on Services - Page 7 of 7 <br />